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known adversarial weapons causing penetrating injury pat­ main difference being the inciting event. Until adequate re­
terns. Mission Oriented Protective Posture (MOPP) personal search has been conducted on treatment for AHIs, USSOCOM
protective equipment (PPE) was created as protection against has recommended using the Clinical Practice Guidelines for
6
known biological and chemical weapon threats. Protection TBI. Mild to moderate TBIs are managed acutely with med­
and prevention for neuroweapons become difficult without a ications and therapies directed toward symptoms, removal of
knowledge of the delivery or mechanism of injury. stimuli from the environment, and progressive return to activ­
ity as symptoms resolve. Persistent sequelae receiver further
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Although not expressly validated, government sources point management and referrals based on the specific symptoms.
to Russia as the most likely culprit. Many of these attacks Education and conservative management in the acute phase of
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have happened in countries in which Russia maintains a large AHI/TBI is paramount in treatment but requires the identifi­
presence (Cuba, Georgia, Poland, Austria, and a few Central cation and reporting of symptoms by patients, reinforcing the
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Asian countries). The fact that Russia has a historic interest need for the “recognize and respond” phase. The different
in microwave energy and claims to have started development categories of long­term sequelae summarized by Biggs et al
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of this sort of weapon in 2012 suggests Russian involvement. necessitate management by specialist centers, such as the Na­
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If SOF personnel are operating in areas where Russians—par­ tional Intrepid Center of Excellence (NICoE). Even without a
ticularly Russian intelligence services—have a presence, then traumatic inciting event, military medical professionals should
the likelihood of being at risk of neuroweapons is higher. SOF be open to using current TBI guidelines and management strat­
and their medical personnel should work with the local intelli­ egies for the treatment of neurological AHI patients.
gence office to best understand the threat environment and be
more vigilant than usual.
Conclusion
Some health agencies already recognize the need for vigilance. Over the last few years, members of the Department of De­
For example, the Defense Health Agency has a small business fense, Department of State, and the Intelligence Community
innovation research (SBIR) request to “develop a low cost, have been exposed to a new threat causing neurological prob­
low weight, small size wearable radio frequency (RF) weapon­ lems and evidence of brain damage. Although some initial
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exposure detector.” This is a first step in developing preven­ theories dismissed the patients’ symptoms as psychological,
tive measures and protective equipment to shield operators. further research has led to concerns about the weaponiza­
More attention and broader awareness will spark innovation tion of directed energy. The potential for neuroweapons puts
and competition. As with any new equipment, operators must high­value targets, such as intelligence officers, diplomats, and
balance the risks between the injury­prevention measures it Special Operators, at higher risk for targeting and sustaining
provides and how much it limits the ability to shoot, move, neurological injuries. This non­lethal domain of warfare is the
and communicate. Medical personnel should educate mission centerpiece of human cognition and serves as the foundation
commanders on potential neuroweapon exposure risks to help for all other domains of warfare, increasing the significance
mission risk­mitigation decisions. for developing a medical counterstrategy.
Recognize and Respond Because of the lack of information regarding the weapons, their
If prevention and protection are inadequate or unachievable, technology, and the entity using the weapons, SOF operators
then the weapon’s long­term health implications can be re­ and medical personnel must use a strategy like counter­WMD
duced with proper recognition and response. Operators at passive defense to minimize sustained injuries. Until more re­
risk for chemical weapon exposure are issued autoinjector kits search is conducted to identify prevention and means of pro­
containing atropine and pralidoxime (2­PAM) to counter or­ tection, medical personnel should focus on first educating the
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ganophosphate nerve agents. Prior to deployment, they re­ Force on the potential for an attack, then establishing criteria
ceive training on how to identify symptoms of possible nerve to help prevent an exposure, recognize and respond when tar­
agents (recognize) and are instructed to use their kits (respond) geted, and plan for long­term treatment and recovery of vic­
if there are signs or symptoms of exposure. 25 tims. Although these weapons are non­lethal, attacks pose a
significant threat to the combat effectiveness of our Force.
Medical research into the injury patterns of suspected neu­
roweapons will help educate at­risk combatants in the recog­ References
nition of potential exposure. The recent AHI symptoms mimic 1. Entous A, Anderson JL. The mystery of the Havana Syndrome.
those of TBI but without the typical blast or blunt trauma, The New Yorker. November 9, 2018 issue. https://www.new
signaling a possible exposure to a neuroweapon. Without this yorker.com/magazine/2018/11/19/the­mystery­of­the­havana­
recognition, a response, including removal from the exposure syndrome. Accessed 28 July 2021.
and reporting the event for investigation, will not be triggered. 2. US Special Operations Command. Policy Memorandum 20-02:
Unconventionally Acquired Brain Injury Reporting and Health
Medical personnel should be responsible for training their unit Guidance for Special Operations Forces. 2020.
in recognition and response. Emphasis should be placed on the 3. Austin LJ III. Anomalous Health Incidents. Memorandum. 15 Sep­
potential long­term effects if symptoms are ignored and ex­ tember 2021. https://media.defense.gov/2021/Sep/15/2002855031/
posure allowed to continue, so that mission commanders and ­1/­1/1/Anomalous­Health­Incidents.PDF.
operators can make well­informed, risk­stratified decisions. 4. SOFWERX. J5 Donovan Group Radical Speaker Series: Neuro­
weapons. https://www.sofwerx.org/neuroweapons/. Accessed 24
August 2021.
Treat and Recover 5. Krishnan A. Military Neuroscience and the Coming Age of Neuro-
The treatment and recovery phase involves medical profession­ warfare. 1st ed. New York, NY: Routledge, Taylor & Francis
als diagnosing and managing injuries, providing required ther­ Group; 2018.
apies, and assisting with recovery. The neurological symptoms 6. Biggs AT, Henry SM, Johnston SL, Whittaker DR, Littlejohn LF.
of AHI are nearly indistinguishable from those of TBI, with the Unconventionally acquired brain injury: guidance and instruction

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